Using Social Convoy Theory to Identify and Recruit Caregivers of Older Adults with Serious Illness for Palliative Care Research: A Comparative Analysis

Dear Editor:

Older adults with serious illness often endure significant physical and psychological burdens, progressively becoming more dependent on their caregivers.¹ Although care for older adults is often shared among networks of caregivers, most caregiving research and interventions target individual caregivers or patient-caregiver dyads. There is a need for research that conceptualizes complex caregiving networks and provides evidence for family or network-based interventions.¹

Identifying and recruiting caregivers for palliative care research is challenging.² Older adults may hesitate to name caregivers owing to concern over burdening them. Once identified, caregivers often lack time, resources, and support to participate in research, and many do not see themselves as caregivers but merely helpers. Recruiting caregivers in the setting of serious illness can have additional challenges related to the intensity of care, grief, and bereavement. Importantly, patients and caregivers must all be interested in study participation and participating together. Social Convoy Theory, a framework for capturing social support over the lifespan, may be a helpful recruitment model as it is well-established in social science literature and illustrates the complex relationships within caregiving networks.³

As part of a larger qualitative project to engage older adults and their caregivers in palliative care research,⁴ we compared two recruitment methods that were used to maximize caregiver identification and recruitment: (1) the “Helpers” Strategy, which directly asks older adults about who helps them with their health, and (2) the “Social Convoy” Strategy, which uses a Social Convoy approach to create a social support diagram. Both strategies involved contacting identified caregivers via phone, email, and text for recruitment. Descriptive analysis of the two strategies leveraged a data visualization tool, Tableau, to examine data.

Both strategies successfully identified at least one caregiver among 77%–78% of the 31 older adults enrolled in the qualitative study, resulting in the identification of 49 caregivers (Fig. 1). For the Helper Strategy, we identified n = 18 caregivers from 13 older adults, yielding 1.5 caregivers per participant. For the Social Convoy Strategy, we identified n = 31 caregivers from 18 older adults, yielding 1.72 caregivers per participant. However, when a caregiver was identified, the Helper Strategy primarily identified only 1 caregiver (46%) and between 2–5 caregivers 31% of the time while the Social Convoy Strategy identified 1 caregiver (33%), 2–5 caregivers (45%), and identified one convoy of 6 caregivers. Recruitment efforts resulted in a 61.2% caregiver participation rate and was higher among the Helper Strategy than Social Convoy, 66.7% versus 58.1%. Older adults in the Helper Strategy had only 1 caregiver participate in an interview most of the time (67%) and 2 caregivers 17% of the time. The Social Convoy strategy resulted in interviews with 1 caregiver (50%) and 2+ caregivers (22%) including participation with 3 caregivers.

FIG. 1.

Visual Description of the Number of Caregivers Identified per Older Adult Participant and Caregiver Participation in a Study Interview.

Overall, the combined strategies resulted in successful caregiver recruitment. The Social Convoy approach facilitated the identification of a broader caregiving network, despite a lower overall recruitment rate. These findings suggest that the Social Convoy framework could be a promising method for identifying caregivers for research, providing a more comprehensive understanding of caregiving networks.

Funding Information

Dr. Portz is funded by a career development award from the National Institute on Aging (K76AG059934).